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Lollipop containing ketamine (50 mg) was evaluated for the premedication of pediatric patients. The subject of this study were 12 children aged from 1 year 7 months to 6 years. They received the lollipop and showed relatively good emotional state and no typical side effects. These results suggest good possibility of ketamine lollipop as the premedication for pediatric patients.
The sympathetic suppressant properties of Thalamonal as a premedication is reported in both normotensive and hypertensive patients. The investigations were carried out in 27 patients altogether, of whom 7 were previously treated hypertensives. The plasma catecholamines noradrenaline and adrenaline, the blood pressure and heart rate were monitored before and after premedication.
We examined the necessity of sedative premedication for elective operation of childhood when induction was performed beside the mother. One hundred and nine patients (aged from 2 to 8 years) were assigned randomly to two groups; midazolam (0.5 mg.kg-1, orally, n = 56) was administered 45 min before induction in Group M, and vehicle was administered (n = 53) in Group C. The differences between the two groups about their calmness and behavior were investigated using double blind method, and analyzed according to their ages, as infants (2 to 4 years), kindergarteners (5 to 6 years) and school children (7 to 8 years). The significantly higher incidences of agitation or alertness were observed in infants of Group C (P < 0.05) and all other patients were calm and well sedated. We conclude that sedative premedication is necessary in infants even if induction is performed beside patient's mothers.
The effect of chlorprothixene (Taractan), a neuroleptic agent, administered either intramuscularly (1 mg/kg) or orally as a 4% solution (1,5-2 mg/kg), was compared in a double-blind study in 200 children between 11 months and 10 years of age. In addition, intramuscular 1-hyoscyamine (Bellafolin) was given to all patients 30 minutes before the induction of anaesthesia (0.005-0.01 mg/kg). With regard to antisalivary action, suppression of reflex irritability, frequency of post-anaesthetic vomiting, postoperative sedation and requirement of postoperative analgesics, there was no significant difference between the two methods. Preoperative sedation was slightly more pronounced with the intramuscular technique. An undesirable side-effect, hypotension, was observed more often after intramuscular than oral premedication. To obtain optimum effect, an interval of 2 hours between the oral premedication and induction of anaesthesia is recommended.
Weekly administration of paclitaxel with a short course of premedication was performed for 8 patients with advanced or recurrent gastric cancer. In this regimen, 500 ml of physiological saline with vitamins was administered in a 3-hour infusion. After 30 minutes of infusion, dexamethasone 10 mg, chlorpheniramine maleate 5 mg, famotidine 20 mg and ramosetron hydrochloride 0.3 mg were administered intravenously. After 30 more minutes of infusion, paclitaxel at a dose of 65 mg/m2 was admixed in the residual normal physiological saline and administered over 2 hours. Administration was continued for 3 weeks with a 1 week rest. Though the partial response rate was 25%, clinical symptoms improved in all patients. Moreover, both hematological and non-hematological toxicities were mild. Weekly administration of paclitaxel with a short course of premedication is an effective and well-tolerated method for patients with advanced or recurrent gastric cancer.
Apart from sufficient experience on the part of the examining physician and adequate technical apparatus, proper premedication can facilitate the procedures for both patient and physician considerably. The paper reports on experience gained in 500 laparoscopies carried out under conditions which were deviated slightly from those hitherto recommended in the literature. The analgesic employed was Tilidine (in Germany: Valoron), and Diazepam was used as a sedative; both of these substances were given intravenously, the vein was kept open for the entire course of the examination. The Tilidine dose was normally 50-100 mg, but under exceptional circumstances as much as 150 mg. Tilidine showed good analgesic effectiveness and tolerance; no case or nausea or vomiting and no sign of respiratory depression of effects on smooth muscle were observed under the conditions stated. The fact that Tilidine is not subject to the restrictions imposed by the German narcotics law is also seen as an advantage. The Diazepam dose was 5-30 mg. Apart from its sedative effect Diazepam also diminishes the tonus of skeletal muscle (important in laparoscopy) and has a relatively long time of elimination (20-48 h). In addition to these two substances, 10-20 ccm of 1% Lidocaine solution with Epinephrine additive was given as a local anaesthetic. The investigators' experience with the above premedication procedure was found to be convincingly positive.
OBJECTIVES: To analyse reports of antivenom use and sequelae in Australia from July 1 1989 to June 30 1990. The value of snake venom detection kits (VDKs) was also analysed. METHODS: Information was obtained from antivenom usage reports returned to the Commonwealth Serum Laboratories and from personal letters sent to those reporting doctors. Information on VDKs was obtained from antivenom usage reports or from questionnaires packaged with VDKs. RESULTS: Reported antivenoms used were: red-back spider, 258 cases; funnel-web spider, 3 cases; stonefish, 26 cases; box jellyfish, 6 cases; snake, 91 cases. Immediate reactions followed administration of red-back spider antivenom in only two patients and snake antivenoms in four patients. Delayed reactions (serum sickness) followed use of red-back spider antivenom in three patients, stonefish antivenom in two, and snake antivenoms in three. No reaction was life-threatening. Premedication was used in the majority of red-back spider bites and in 66 of 86 snake bites. Oral corticosteroids were given prophylactically after some uses of snake antivenom to prevent serum sickness. VDKs were used in 181 cases of snake bite and were reported as being useful in selecting appropriate snake antivenom in 31% of cases of antivenom use. (Only 10 of these 181 were also reported on the antivenom usage report.) Appropriate first aid was given in 61% of cases. There were 50% fewer snake bites reported than 10 years ago. CONCLUSIONS: Antivenoms in Australia are well tolerated with few immediate or delayed reactions. The use of premedication and prophylactic oral corticosteroids for four to five days after antivenom administration may be responsible for this low reaction rate. VDK results help select the appropriate antivenom; however, in some cases positive results were obtained from urine samples from patients with no symptoms of envenomation.
Nurses play an essential role in preparing patients for surgical procedures, whether the operation is planned or an emergency. Part of this preparation may include administration of premedication. Government initiatives such as The NHS Plan (Department of Health, 2000) and Essence of Care (DoH, 2001) emphasise the need to get the fundamental aspects of nursing care right, and nurses have a professional responsibility to deliver evidence-based care (NMC, 2002). Additionally, the publication of Building a Safer NHS for Patients: Improving Medication Safety (DoH, 2004) aims to improve patient safety by reducing the incidence of drug errors. This article looks at why pharmacological intervention is no longer a routine preoperative preparation. It will discuss drugs that are used to aid anaesthesia and those used as prophylaxis to aid postoperative recovery, consider the ways in which premedication can now include psychological interventions, and look at the nurse's role.
Problem of clofellinum (clonidine) usage in premedication in aged persons with arterial hypertension is discussed. Clofellinum usage may be effective of prevention of intraoperative hypertensive reactions in abdominal surgery. Clofellinum is usefull component of premedication especially in patients with non-cared arterial hypertension and in the case of its usage as permanent non-hypertensive drug. The patients with good-controlled arterial hypertension are needed in prolonged hypotensive therapy during preoperative period.
Pulmonary damage after aspiration of acid gastric content is one of the major risks of general anaesthesia. Antisecretory therapy with different H2-antagonists can effectively decrease the risk of aspiration. The effective dosage and the method and timing of administration remain unclear. PATIENTS AND METHODS. A series of 38 patients scheduled for elective cardiac surgery (coronary artery bypass graft) were premedicated at random at 10:00 p.m. on the evening prior to surgery with famotidine 40 mg and flunitrazepam 0.5 mg p.o. or with flunitrazepam alone. Continuous intragastric pH monitoring (720 values/h) with a combined glass electrode was started immediately after induction and continued for at least 12 h after surgery, in most cases up to extubation. The time periods analyzed were the first 30 min after induction, time of surgery, 12 h after surgery, and time of extubation. For each period the number of pH values less than 2.5 and pH less than 4, mean and median, and significance of differences were calculated. STATISTICS. Test statistics were evaluated using the Wilcoxon test and the Mann-Whitney U-test. RESULTS. (see Table 1, Fig. 1). The mean time interval between oral premedication and induction of anaesthesia was 9.7 h. There were no differences between the groups concerning age and duration of surgery. The average age was 51 in the group of treated patients (n = 15) and 59 years in the control group (n = 23). The average duration of surgery was 3.36 h and 4.02 h. During induction and in the following 30 min, in the famotidine treatment group 28.7% of all pH values were pH less than 2.5, as against 45.4% in the control group (P = 0.08). Intraoperative values: 16.3% pH less than 2.5 against 24.7% (not significant); 12 h postoperative: 21.1% vs 17.8% and during extubation 40% vs 21% (not significant). During induction there were more pH values less than 2.5 in the control than in the treatment group (P = 0.08). Treated patients had nearly 30% pH values less than 2.5 and therefore, a persisting risk of acid aspiration. In both groups intragastric acidity decreased during surgery. Postoperatively there was no difference between the two groups, and during extubation more patients in the famotidine-treated group had values below pH 2.5. CONCLUSION. Prophylaxis of acid aspiration before, during and after cardiac surgery can be achieved by increasing the pH of the gastric content. The timing and the method of administration must be selected to a safe decrease in intragastric acidity before the induction of general anaesthesia. Famotidine 40 mg given orally at 10.00 p.m. on the evening before surgery is not a reliable means of decreasing intragastric acidity or, consequently, of preventing of acid aspiration syndrome.
BACKGROUND: Many investigations have focused on optimal doses/schedules since regulatory agency approval of paclitaxel (Taxol). Paclitaxel is generally administered at doses of 175-225 mg/m2 over 3 hours or 135-175 mg/m2 over 24 hours, every 3 weeks. The purpose of this study was to simplify administration and render it suitable and practical in the outpatient setting. Using this rationale, the duration of administration was decreased to one hour, with a minimized premedication regimen. MATERIAL/METHODS: One hundred patients who were to receive paclitaxel-based chemotherapy combinations entered the study. Tumor types were non-small-cell lung cancer (NSCLC, n=40), small-cell lung cancer (SCLC, n=18), breast cancer (n=12), head and neck cancer (n=16), and ovarian cancer (n=14). Sixty patients received paclitaxel at 175 mg/m2 and the remaining 40 at 225 mg/m2. The premedication regimen consisted of a single dose of dexamethasone 20 mg, dimethindene maleate (Fenistil) 4 mg, and ranitidine (Zantac) 50 mg, followed by the standard antiemetic therapy. Paclitaxel was always administered before other chemotherapeutic agents, i.e. ifosfamide and/or platinum compounds, except for breast cancer, where epirubicin preceded paclitaxel administration. RESULTS: Hypersensitivity reactions were recorded in 7 patients (7.0%) and were not influenced by age, gender, disease, dose schedule, or cycles of therapy. No serious adverse events were observed. CONCLUSIONS: The simplified administration dose schedule for paclitaxel is safe and accommodates its combination with other cytostatic agents.
Pyralgin (metamizole sodium) usefulness was tested in premedication of 90 patients subjected to processing of hard tooth tissues by grinding or drilling. The results of the study demonstrated that about 2/3 of the patients failed to observe any difference in the painfulness of the procedure with and without premedication with Pyralgin. In 1/3 of the patients Pyralgin reduced pain, improved wellbeing and raised the emotional status during the procedure. This effect might be regarded as a placebo result.
This study was undertaken with a view to assessing the effectiveness and tolerance of tiropramide hydrochloride in the premedication of endoscopic rectosigmoidoscopy. The following were considered for this purpose: 1) speed of execution of the procedure; 2) its tolerance; 3) possible complications. The effectiveness of tiropramide was also examined in uncomplicated diverticular disease: 1) comparison of execution times for rectosigmoidoscopy before and after therapy; 2) the evaluation of the reduction in symptomatology. The patients were subdivided into three groups: 1st group submitted to diagnostic rectosigmoidoscopy; 2nd group submitted to therapeutic rectosigmoidoscopy; 3rd group with diverticular disease. In the first group, execution times were less than 20 minutes in all cases bar 1 and tolerance was good in 27 cases, average in 3. In the second group, times were less than 15 minutes in 6 cases and higher in 4, and tolerance was good in 7 cases and average in 3. In the third group (10 patients), examination execution time was reduced after therapy in 9 cases and in the same number pain symptomatology regressed. Tiropramide proved to be the antispastic of choice in premedication for rectosigmoidoscopy and an effective drug in the treatment of uncomplicated diverticular disease.
The efficacy of oral atropine premedication in attenuation of the cardiovascular depression associated with halothane anesthesia has not been previously evaluated. A solution containing either oral atropine 0.04 mg/kg (HI), 0.02 mg/kg (LO), or a placebo (NO) was randomly administered to 36 infants 1-6 months old and 36 infants 7-15 months old 30-90 minutes before induction of anesthesia. The onset of action of atropine was approximately 25 minutes after administration as determined by a 15% increase in heart rate (HR) above baseline levels. Heart rate, systolic blood pressure (SBP), and mean arterial blood pressure (MAP) were then measured at 1-minute intervals starting just before induction of anesthesia and continuing until onset of surgical stimulation during anesthesia with halothane (up to 3%), nitrous oxide (60%), and oxygen (40%). In infants 1-6 months old, either dosage of oral atropine preserved HR and SBP as compared with placebo. In infants 7-15 months old, either dosage preserved HR but not SBP. The severity of hypotension was greatest in infants 1-6 months of age given placebos. No significant differences existed between oral atropine 0.04 mg/kg or 0.02 mg/kg in either age range. It is concluded that premedication with oral atropine 0.02 mg/kg is effective in attenuating the cardiovascular depression associated with halothane anesthesia in infants.
The systolic blood pressure, pulse rate and respiratory rate were assessed in 112 children before and after receiving premedication consisting of trimeprazine (3 mg/kg) and droperidol (0.2 mg/kg) by mouth. A mild (10%) drop in blood pressure was shown, but no statistical difference was found in the other parameters measured. The premedication is highly efficacious, 70% of patients being asleep in the preanaesthetic room; 27% were calm and only 3% were distressed or crying.
The author presents the results obtained with Faustan (diazepam) in the premedication of ambulatory stomatological interventions at a university clinic of stomatology. Experience was acquired in particular with intravenous premedication in a climical study involving 340 patients. The findings from this study and the experience with hundreds of ambulatory interventions in the past several years characterize Faustan, on condition of individual dosage, as a premedicant that is well suited for stomatological interventions, does not impair vital functions, increases the patients' willingness to co-operate and is of considerable anxiolytic activity. The use of Faustan is recommended for stomatological emergency situations and risk patients.
Euthanasia of unwanted or sick animals should always be done in a humane manner. This study involving two groups of 12 dogs evaluated a two step method of euthanasia using first acepromazine or pentazocine then inhalation of carbon monoxide. During the experiment, behavioral reactions (anxiety, agitation, vocalization and sphincter relaxation) and physiological parameters (electro-encephalogram, electrocardiogram, arterial blood pressure, respiratory and heart rates and serum cortisol) were monitored. The results showed that both drugs modified many behavioral reactions and physiological changes associated with administration of carbon monoxide. Acepromazine and pentazocine reduced by 25% and 20% respectively the number of dogs that showed vocalization and agitation. In acepromazine premedicated dogs, the duration of these signs was significantly diminished and sphincter relaxation did not occur in more than 50% of cases. Furthermore, with the use of acepromazine, no significant peaks or drastic drops were noticed in the heart and respiratory rates and in the arterial blood pressure. These manifestations are usually related to stress. In light of these results, it is recommended to premedicate dogs with acepromazine before submitting them to euthanasia by carbon monoxide inhalation.
Dixyrazine (Esucos) as premedication for esophagogastroscopy was studied in a double-blind trial with diazepam and atropine in 321 successive endoscopies. It was established that dixyrazine was fairly well tolerated, regurgitation was significantly reduced. A distinct antiemetic effect was observed compared with diazepam; the difference was statistically significant in the male patients. Dixyrazine may be regarded as a fairly good alternative premedication for esophagogastroscopy.